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==Overview==
==Overview==
Sinus bradycardia does not necessarily refer to the presence of an obvious pathology; in fact, it may occur in normal, healthy individuals including well-trained [[athletes]], some [[elderly]] people or during [[sleep]].  It may also be due to an exaggerated response to normal physiological processes (e.g. [[vomiting]], [[coughing]], [[defecation]]) or from pathologies involving the [[SA node]] such as [[sick sinus syndrome]], [[myocardial infarction]].  The most common medications causing sinus bradycardia are [[beta blockers]], [[digitalis]] and [[calcium channel blockers]].  However, life-threatening conditions including chemical [[poisoning]] ([[organophosphate]], [[sarin]]), [[sepsis]], [[electrolyte imbalance]] should be promptly recognized and treated.


==Causes==
==Causes==


===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*[[Beta blockers#Adverse effects|Beta blocker overdose]]
*[[Carbamate|Carbamate poisoning]]
*[[Cervical spine injury]]
*[[Digitalis toxicity]]
*[[Drowning]]
*[[Electric shock]]
*[[Electrolyte imbalance]]
*[[Hypoglycemia]]
*[[Intracranial pressure#Increased ICP|Increased intracranial pressure]]
*[[Lily of the Valley|Lily of the valley poisoning]]
*[[Lithium toxicity]]
*[[Myocardial infarction]]
*[[Nerve agent|Nerve agent poisoning]] e.g. [[sarin]]
*[[Organophosphate poisoning]]
*[[Rabies]]
*[[Sepsis]]


===Common Causes===
===Common Causes===
*[[Aging]]
*[[Beta blocker]]
*[[Calcium channel blocker]]
*[[Cardiac catheterization]]
*[[Electrolyte imbalance]]
*[[Hypothermia]]
*[[Hypothyroidism]]
*[[Myocardial infarction]]
*[[Nausea]]
*[[Obstructive sleep apnea]]
*[[Sedative]]
*[[Sepsis]]
*[[Sleep]]
*[[Sick sinus syndrome]]


===Causes by Organ System===
===Causes by Organ System===
 
{|style="width:75%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Carotid sinus hypersensitivity]], [[endocarditis]], [[hypertrophic cardiomyopathy]], [[left ventricular noncompaction]], [[LQT4|LQT4 mutation]], [[myocardial infarction]], [[myocarditis]], [[pericarditis]], [[sick sinus syndrome]], [[vasovagal syncope]]
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Carbamate|Carbamate poisoning]], [[Lily of the Valley|lily of the valley poisoning]], [[nerve agent]], [[organophosphates]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Adenosine]], [[alfentanil]], [[ambenonium]], [[amiodarone]], [[atenolol]], [[bethanechol]], [[bupivacaine]], [[calcium channel blocker]], [[celecoxib]], [[cilobradine]],<ref name="van bogaert-2003">{{cite journal  | last1 = van bogaert | first1 = pp. | last2 = pittoors | first2 = f. | title = use-dependent blockade of cardiac pacemaker current (if) by cilobradine and zatebradine. | journal = eur j pharmacol | volume = 478 | issue = 2-3 | pages = 161-71 | month = oct | year = 2003 | doi =  | pmid = 14575801 }}</ref> [[citalopram]], [[clonidine]], [[deserpidine]], [[diltiazem]], [[dimethyl sulfoxide]], [[distigmine]], [[dronedarone]], [[febuxostat]], [[fentanyl]],[[fingolimod]], [[flecainide]], [[fosphenytoin]], [[grayanotoxin]], [[Granisetron]], [[guanethidine]], [[H2 receptor antagonist]], [[ivabradine]], [[lanreotide]], [[lidocaine]], [[lofexidine]], [[mefloquine]], [[methyldopa]], [[mexiletine]], [[muscarine]], [[nadolol]], [[nefazodone]],[[neostigmine]], [[octreotide]], [[paclitaxel]], [[palonosetron]], [[physostigmine]], [[procainamide]], [[propranolol]], [[quinidine]], [[rabeprazole]], [[regadenoson]], [[reserpine]], [[sedative]], [[somatostatin]], [[sotalol]], [[sufentanil]],[[suxamethonium]], [[toluene|toluene sniffing]], [[cocaine|topical cocaine]], [[verapamil]], [[veratridine|veratridine (false hellebore)]], [[zaleplon]], [[zatebradine]] <ref name="Van Bogaert-2003">{{Cite journal  | last1 = Van Bogaert | first1 = PP. | last2 = Pittoors | first2 = F. | title = Use-dependent blockade of cardiac pacemaker current (If) by cilobradine and zatebradine. | journal = Eur J Pharmacol | volume = 478 | issue = 2-3 | pages = 161-71 | month = Oct | year = 2003 | doi =  | PMID = 14575801 }}</ref>
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cretinism]], [[diabetic neuropathy]], [[hemochromatosis]], [[hypothyroidism]], [[tumor lysis syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Altitude sickness]], [[decompression sickness]], [[electric shock]], [[hypothermia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Arnold-Chiari malformation]], [[cretinism]], [[HCN4|HCN4 mutation]], [[hemochromatosis]], [[LQT4|LQT4 mutation]], [[myotonic dystrophy ]], [[Nav1.5|SCN5A mutation]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Hemochromatosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cardiac catheterization]], [[cardiac transplantation]], [[Toluene|toluene sniffing]], [[transcatheter aortic valve implantation]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Babesiosis]], [[brucellosis]], [[Chagas disease]], [[dengue fever]], [[diptheria]], [[legionellosis]], [[leptospirosis ]], [[Lyme disease]], [[malaria]], [[meningitis ]], [[Q fever ]], [[rabies]], [[rheumatic fever]], [[rocky mountain spotted fever]], [[sepsis ]], [[trichinosis]], [[typhoid fever]], [[typhus]], [[viral hemorrhagic fever]], [[yellow fever]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Myotonic dystrophy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cerebral edema]], [[diabetic neuropathy]], [[epilepsy]], [[Intracranial pressure#Increased ICP|increased intracranial pressure]], [[meningitis]], [[rabies]], [[subarachnoid hemorrhage]], [[vasovagal syncope]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Hypoglycemia]], [[kwashiorkor]], [[sepsis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Pregnancy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Crizotinib|Crizotinib toxicity]], [[digitalis toxicity]], [[fluoxetine]], [[fluvoxamine]], [[Ibutilide|ibutilide toxicity]], [[lithium toxicity]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Anorexia nervosa]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cough syncope]], [[drowning]], [[hypercapnia]], [[obstructive sleep apnea]], [[sarcoidosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Hypercalcemia]], [[hyperkalemia]], [[hypermagnesemia]], [[hypokalemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Amyloidosis]], [[neonatal lupus erythematosus]], [[rheumatoid arthritis]], [[sarcoidosis]], [[scleroderma]], [[systemic lupus erythematosus]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cervical spine injury]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 122: Line 153:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Aging]], [[altitude sickness]], [[decompression sickness]], [[defecation]], [[drowning]], [[micturition syncope]], [[nausea]], [[sleep]], [[starvation]], [[Physical exercise|trained athletes]], [[valsalva maneuver]], [[vomiting]]
|-
|-
|}
|}
Line 129: Line 160:
{{col-begin|width=80%}}
{{col-begin|width=80%}}
{{col-break|width=33%}}
{{col-break|width=33%}}
*[[Aging]]
*[[Alfentanil]]
*[[Altitude sickness]]
*[[Ambenonium ]]
*[[Amiodarone]]
*[[Amyloidosis]]
*[[Anorexia nervosa]]
*[[Arnold-Chiari malformation]]
*[[Atenolol]]
*[[Babesiosis]]
*[[Bethanechol]]
*[[Bezold-Jarisch reflex]]
*[[Brucellosis]]
*[[Bupivacaine]]
*[[Calcium channel blocker]]
*[[Carbamate|Carbamate poisoning]]
*[[Cardiac catheterization]]
*[[Cardiac transplantation]]
*[[Carotid sinus hypersensitivity]]
*[[Celecoxib]]
*[[Cerebral edema]]
*[[Cervical spine injury]]
*[[Chagas disease]]
*[[Cilobradine]]<ref name="Van Bogaert-2003">{{Cite journal  | last1 = Van Bogaert | first1 = PP. | last2 = Pittoors | first2 = F. | title = Use-dependent blockade of cardiac pacemaker current (If) by cilobradine and zatebradine. | journal = Eur J Pharmacol | volume = 478 | issue = 2-3 | pages = 161-71 | month = Oct | year = 2003 | doi =  | PMID = 14575801 }}</ref>
*[[Citalopram]]
*[[Clonidine]]
*[[Cough syncope]]
*[[Cretinism]]
*[[Crizotinib|Crizotinib toxicity]]
*[[Decompression sickness]]
*[[Defecation]]
*[[Dengue fever]]
*[[Deserpidine ]]
*[[Diabetic neuropathy]]
*[[Digitalis toxicity]]
*[[Diltiazem]]
*[[Dimethyl sulfoxide]]
*[[Diptheria]]
*[[Distigmine]]
*[[Dronedarone]]
*[[Drowning]]
*[[Electric shock]]
*[[Endocarditis]]
*[[Epilepsy]]
*[[Febuxostat]]
*[[Fentanyl]]
*[[Fingolimod]]
*[[Flecainide]]
*[[Fluoxetine]]
{{col-break|width=33%}}
*[[Fluvoxamine]]
*[[Fosphenytoin]]
*[[Grayanotoxin]]
*[[Guanethidine]]
*[[H2 receptor antagonist]]
*[[HCN4|HCN4 mutation]]
*[[Hemochromatosis]]
*[[Hypercalcemia]]
*[[Hypercapnia]]
*[[Hyperkalemia]]
*[[Hypermagnesemia]]
*[[Hypertrophic cardiomyopathy]]
*[[Hypoglycemia]]
*[[Hypokalemia]]
*[[Hypothermia]]
*[[Hypothyroidism]]
*[[Ibutilide|Ibutilide toxicity]]
*[[Intracranial pressure#Increased ICP|Increased intracranial pressure]]
*[[Ivabradine]]
*[[Kwashiorkor]]
*[[Lanreotide]]
*[[Left ventricular noncompaction]]
*[[Legionellosis]]
*[[Leptospirosis]]
*[[Lidocaine]]
*[[Lily of the Valley|Lily of the valley poisoning]]
*[[Lithium toxicity]]
*[[Lofexidine]]
*[[LQT4|LQT4 mutation]]
*[[Lyme disease]]
*[[Malaria]]
*[[Mefloquine]]
*[[Meningitis]]
*[[Methyldopa]]
*[[Mexiletine]]
*[[Micturition syncope]]
*[[Miller-Dieker syndrome]]
*[[Muscarine]]
*[[Myocardial infarction]]
*[[Myocarditis]]
*[[Myotonic dystrophy]]
*[[Nadolol]]
*[[Nausea]]
*[[Nefazodone]]
*[[Neonatal lupus erythematosus]]
*[[Neostigmine]]
*[[Nerve agent]]
*[[Obstructive sleep apnea]]
*[[Organophosphates]]
{{col-break|width=33%}}
*[[Paclitaxel]]
*[[Palonosetron]]
*[[Pericarditis]]
*[[Physostigmine]]
*[[Pregnancy]]
*[[Procainamide]]
*[[Propranolol]]
*[[Q fever]]
*[[Quinidine]]
*[[Rabeprazole]]
*[[Rabies]]
*[[Regadenoson]]
*[[Reserpine]]
*[[Rheumatic fever]]
*[[Rheumatoid arthritis]]
*[[Rocky mountain spotted fever]]
*[[Sarcoidosis]]
*[[Scleroderma]]
*[[Nav1.5|SCN5A mutation]]
*[[Sedative]]
*[[Sepsis]]
*[[Sick sinus syndrome]]
*[[Sleep]]
*[[Somatostatin]]
*[[Sotalol]]
*[[Starvation]]
*[[Subarachnoid hemorrhage]]
*[[Sufentanil]]
*[[Suxamethonium]]
*[[Systemic lupus erythematosus]]
*[[Toluene|Toluene sniffing]]
*[[Cocaine|Topical cocaine]]
*[[Physical exercise|Trained athletes]]
*[[Transcatheter aortic valve implantation]]
*[[Trichinosis]]
*[[Tumor lysis syndrome]]
*[[Typhoid fever]]
*[[Typhus]]
*[[Valsalva maneuver]]
*[[Vasovagal syncope]]
*[[Verapamil]]
*[[Veratridine|Veratridine (false hellebore)]]
*[[Viral hemorrhagic fever]]
*[[Vomiting ]]
*[[Yellow fever]]
*[[Zaleplon]]
*Zatebradine<ref name="Van Bogaert-2003">{{Cite journal  | last1 = Van Bogaert | first1 = PP. | last2 = Pittoors | first2 = F. | title = Use-dependent blockade of cardiac pacemaker current (If) by cilobradine and zatebradine. | journal = Eur J Pharmacol | volume = 478 | issue = 2-3 | pages = 161-71 | month = Oct | year = 2003 | doi =  | PMID = 14575801 }}</ref>
{{col-end}}
{{col-end}}


Latest revision as of 07:36, 3 February 2015

Sinus bradycardia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]

Overview

Sinus bradycardia does not necessarily refer to the presence of an obvious pathology; in fact, it may occur in normal, healthy individuals including well-trained athletes, some elderly people or during sleep. It may also be due to an exaggerated response to normal physiological processes (e.g. vomiting, coughing, defecation) or from pathologies involving the SA node such as sick sinus syndrome, myocardial infarction. The most common medications causing sinus bradycardia are beta blockers, digitalis and calcium channel blockers. However, life-threatening conditions including chemical poisoning (organophosphate, sarin), sepsis, electrolyte imbalance should be promptly recognized and treated.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Carotid sinus hypersensitivity, endocarditis, hypertrophic cardiomyopathy, left ventricular noncompaction, LQT4 mutation, myocardial infarction, myocarditis, pericarditis, sick sinus syndrome, vasovagal syncope
Chemical/Poisoning Carbamate poisoning, lily of the valley poisoning, nerve agent, organophosphates
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Adenosine, alfentanil, ambenonium, amiodarone, atenolol, bethanechol, bupivacaine, calcium channel blocker, celecoxib, cilobradine,[1] citalopram, clonidine, deserpidine, diltiazem, dimethyl sulfoxide, distigmine, dronedarone, febuxostat, fentanyl,fingolimod, flecainide, fosphenytoin, grayanotoxin, Granisetron, guanethidine, H2 receptor antagonist, ivabradine, lanreotide, lidocaine, lofexidine, mefloquine, methyldopa, mexiletine, muscarine, nadolol, nefazodone,neostigmine, octreotide, paclitaxel, palonosetron, physostigmine, procainamide, propranolol, quinidine, rabeprazole, regadenoson, reserpine, sedative, somatostatin, sotalol, sufentanil,suxamethonium, toluene sniffing, topical cocaine, verapamil, veratridine (false hellebore), zaleplon, zatebradine [2]
Ear Nose Throat No underlying causes
Endocrine Cretinism, diabetic neuropathy, hemochromatosis, hypothyroidism, tumor lysis syndrome
Environmental Altitude sickness, decompression sickness, electric shock, hypothermia
Gastroenterologic No underlying causes
Genetic Arnold-Chiari malformation, cretinism, HCN4 mutation, hemochromatosis, LQT4 mutation, myotonic dystrophy , SCN5A mutation
Hematologic Hemochromatosis
Iatrogenic Cardiac catheterization, cardiac transplantation, toluene sniffing, transcatheter aortic valve implantation
Infectious Disease Babesiosis, brucellosis, Chagas disease, dengue fever, diptheria, legionellosis, leptospirosis , Lyme disease, malaria, meningitis , Q fever , rabies, rheumatic fever, rocky mountain spotted fever, sepsis , trichinosis, typhoid fever, typhus, viral hemorrhagic fever, yellow fever
Musculoskeletal/Orthopedic Myotonic dystrophy
Neurologic Cerebral edema, diabetic neuropathy, epilepsy, increased intracranial pressure, meningitis, rabies, subarachnoid hemorrhage, vasovagal syncope
Nutritional/Metabolic Hypoglycemia, kwashiorkor, sepsis
Obstetric/Gynecologic Pregnancy
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity Crizotinib toxicity, digitalis toxicity, fluoxetine, fluvoxamine, ibutilide toxicity, lithium toxicity
Psychiatric Anorexia nervosa
Pulmonary Cough syncope, drowning, hypercapnia, obstructive sleep apnea, sarcoidosis
Renal/Electrolyte Hypercalcemia, hyperkalemia, hypermagnesemia, hypokalemia
Rheumatology/Immunology/Allergy Amyloidosis, neonatal lupus erythematosus, rheumatoid arthritis, sarcoidosis, scleroderma, systemic lupus erythematosus
Sexual No underlying causes
Trauma Cervical spine injury
Urologic No underlying causes
Miscellaneous Aging, altitude sickness, decompression sickness, defecation, drowning, micturition syncope, nausea, sleep, starvation, trained athletes, valsalva maneuver, vomiting

Causes in Alphabetical Order

References

  1. ↑ van bogaert, pp.; pittoors, f. (2003). "use-dependent blockade of cardiac pacemaker current (if) by cilobradine and zatebradine". eur j pharmacol. 478 (2–3): 161–71. PMID 14575801. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 2.2 Van Bogaert, PP.; Pittoors, F. (2003). "Use-dependent blockade of cardiac pacemaker current (If) by cilobradine and zatebradine". Eur J Pharmacol. 478 (2–3): 161–71. PMID 14575801. Unknown parameter |month= ignored (help)


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